Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 6 de 6
Filtrar
Mais filtros

Bases de dados
País/Região como assunto
Tipo de documento
País de afiliação
Intervalo de ano de publicação
1.
J Dermatolog Treat ; 34(1): 2284105, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38010850

RESUMO

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting approximately 1% of the population. The patient journey through the German health care system leads to high disease burden and substantial treatment costs. The EsmAiL study showed that an innovative, interprofessional, multimodal care-concept reduces disease activity and burden of HS compared to standard care. This paper examines the costs of treating HS in Germany and compares them with those of the innovative care concept implemented in EsmAiL. METHODS: EsmAiL was a two-arm, multicenter, prospective randomized controlled trial including 553 adults with HS. The study was registered in the German Clinical Trials Registry (DRKS00022135). The control group (CG) remained in standard care, whereas the intervention group (IG) was referred to specialized so-called 'acne-inversa-centres (AiZ)' where patients were treated with a structured, interdisciplinary approach. The present paper analyses the treatment costs for a subpopulation based on health insurance cost data from the two largest German health insurers. Quality-Adjusted Life Years (QALY) was assessed based on Dermatology Life Quality Index (DLQI). RESULTS: Total annual treatment costs per patient were €3,966.07 in standard care (n = 89) and €3,974.37 in the innovative care (n = 93). The costs per additional QALY amounted to €12,698.72 in the IG. Given the conventional and established threshold of €22,600 to €33,900 per QALY, the innovative treatment in AiZ proved to be cost-effective. CONCLUSION: Treatment costs of HS are substantial and increase with disease severity. The new form of care is cost-effective and is expected to decrease costs in the long run.


A structured, multimodal form of care reduces costs in the treatment of Hidradenitis suppurativa compared to standard care.


Assuntos
Hidradenite Supurativa , Adulto , Humanos , Hidradenite Supurativa/tratamento farmacológico , Análise Custo-Benefício , Estudos Prospectivos , Custos de Cuidados de Saúde , Assistência Ambulatorial , Índice de Gravidade de Doença
2.
Br J Dermatol ; 189(2): 170-179, 2023 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-37132470

RESUMO

BACKGROUND: Hidradenitis suppurativa (HS) is an inflammatory disease of the inverse skin regions that occurs in young women, in particular, and affects approximately 1% of the population. Outpatient care is often inadequate and usually cannot prevent progression. OBJECTIVES: To evaluate in the EsmAiL ('Evaluation eines strukturierten und leitlinienbasierten multmodalen Versorgungskonzepts für Menschen mit Akne inversa') trial whether an innovative care concept can decrease disease activity and burden, and improve patient satisfaction. METHODS: EsmAiL was conducted as a two-arm, multicentre, prospective, randomized controlled trial that included 553 adults with HS. Inclusion criteria were a minimum of three inflammatory lesions and at least a moderate impact of the disease on quality of life. The control group (CG) remained under standard care, while patients in the intervention group (IG) were treated according to a trial-specific, multimodal concept. The primary endpoint was the absolute change in International Hidradenitis Suppurativa Severity Score System (IHS4). RESULTS: In total, 274 patients were randomized to the IG and 279 to the CG. Altogether, 377 attended the final assessment after 12 months of intervention. Participants in the IG (n = 203) achieved a mean improvement in IHS4 of 9.3 points, while the average decrease in IHS4 in patients in the CG (n = 174) was 5.7 points (P = 0.003). Patients treated under the new care concept also reported a statistically significantly higher decrease in pain, Dermatology Life Quality Index and Hospital Anxiety and Depression Scale scores compared with those in the CG (P < 0.001). Patient satisfaction was also statistically significantly higher in the IG compared with the CG (P < 0.001). CONCLUSIONS: The establishment of standardized treatment algorithms in so-called 'acne inversa centres' in the ambulatory setting has a substantial, positive impact on the course of HS and significantly improves patient satisfaction.


Assuntos
Hidradenite Supurativa , Adulto , Humanos , Feminino , Hidradenite Supurativa/terapia , Hidradenite Supurativa/patologia , Qualidade de Vida , Estudos Prospectivos , Efeitos Psicossociais da Doença , Assistência Ambulatorial , Índice de Gravidade de Doença
3.
Int J Dermatol ; 61(12): 1458-1466, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35193164

RESUMO

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma. However, it is rare in pediatric population. Most of the cases of pediatric MF present with hypopigmented patches and/or various other forms, which may often mimic common childhood dermatoses, thereby causing a delay in the diagnosis. There are no established treatment guidelines for pediatric MF. As the progression of childhood MF is extremely rare and it has an indolent course, it is usually diagnosed at an early stage (IA, IB, IIA), and hence phototherapy with a response rate of >80% is a well-established effective treatment in children. However, as recurrences are frequently seen on stopping the therapies, a maintenance regimen and long-term follow-up is equally important. This article reviews the epidemiological factors, clinical presentations, diagnosis, and various treatment modalities used in pediatric MF. We analyzed and compared the data of almost 616 childhood MF cases from various studies undertaken from 1988 to 2021.


Assuntos
Hipopigmentação , Linfoma Cutâneo de Células T , Micose Fungoide , Neoplasias Cutâneas , Criança , Humanos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/terapia , Micose Fungoide/diagnóstico , Micose Fungoide/epidemiologia , Micose Fungoide/terapia , Linfoma Cutâneo de Células T/patologia , Fototerapia
4.
J Dtsch Dermatol Ges ; 17(2): 214-230, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30762963

RESUMO

Basal cell carcinoma (BCC) is the most common malignant tumor among fair-skinned individuals, and its incidence had been steadily rising in the past decades. In order to maintain the highest quality of patient care possible, the German S2k guidelines were updated following a systematic literature search and with the participation of all professional societies and associations involved in the management of the disease. Part 2 addresses issues such as proper risk stratification, the various therapeutic approaches, and prevention as well as follow-up of patients with basal cell carcinoma.


Assuntos
Carcinoma Basocelular/patologia , Programas de Assistência Gerenciada/normas , Qualidade da Assistência à Saúde/normas , Neoplasias Cutâneas/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/prevenção & controle , Carcinoma Basocelular/terapia , Gerenciamento Clínico , Seguimentos , Alemanha/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/prevenção & controle , Guias de Prática Clínica como Assunto , Medição de Risco , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/terapia
5.
PLoS One ; 8(1): e53745, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23341990

RESUMO

BACKGROUND: Ipilimumab, a cytotoxic T-lymphocyte antigen-4 (CTLA-4) blocking antibody, has been approved for the treatment of metastatic melanoma and induces adverse events (AE) in up to 64% of patients. Treatment algorithms for the management of common ipilimumab-induced AEs have lead to a reduction of morbidity, e.g. due to bowel perforations. However, the spectrum of less common AEs is expanding as ipilimumab is increasingly applied. Stringent recognition and management of AEs will reduce drug-induced morbidity and costs, and thus, positively impact the cost-benefit ratio of the drug. To facilitate timely identification and adequate management data on rare AEs were analyzed at 19 skin cancer centers. METHODS AND FINDINGS: Patient files (n = 752) were screened for rare ipilimumab-associated AEs. A total of 120 AEs, some of which were life-threatening or even fatal, were reported and summarized by organ system describing the most instructive cases in detail. Previously unreported AEs like drug rash with eosinophilia and systemic symptoms (DRESS), granulomatous inflammation of the central nervous system, and aseptic meningitis, were documented. Obstacles included patients delay in reporting symptoms and the differentiation of steroid-induced from ipilimumab-induced AEs under steroid treatment. Importantly, response rate was high in this patient population with tumor regression in 30.9% and a tumor control rate of 61.8% in stage IV melanoma patients despite the fact that some patients received only two of four recommended ipilimumab infusions. This suggests that ipilimumab-induced antitumor responses can have an early onset and that severe autoimmune reactions may reflect overtreatment. CONCLUSION: The wide spectrum of ipilimumab-induced AEs demands doctor and patient awareness to reduce morbidity and treatment costs and true ipilimumab success is dictated by both objective tumor responses and controlling severe side effects.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/imunologia , Antígeno CTLA-4/imunologia , Melanoma/tratamento farmacológico , Melanoma/patologia , Neoplasias Cutâneas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/efeitos adversos , Antineoplásicos/imunologia , Antineoplásicos/uso terapêutico , Sistema Endócrino/efeitos dos fármacos , Feminino , Trato Gastrointestinal/efeitos dos fármacos , Humanos , Ipilimumab , Rim/efeitos dos fármacos , Fígado/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Sistema Nervoso/efeitos dos fármacos , Pâncreas/efeitos dos fármacos , Sistema Respiratório/efeitos dos fármacos , Estudos Retrospectivos , Pele/efeitos dos fármacos
6.
J Dtsch Dermatol Ges ; 2(1): 15-23, 2004 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-16281878

RESUMO

In the year 2004 the obligatory introduction of the new hospital funding system based on a Diagnosis Related Groups (DRG) system will become reality for all German hospitals. After all fundamental items of the new G-DRG version were made generally known, the possible consequences had to be considered. The first mandatory German case-based lump sum catalogue differs importantly from the previous payment models and requires intensive study. Economic considerations will increasingly play a role in the daily routine of hospitals and influence treatment patterns. Therefore, comprehensive knowledge of basic principles of G-DRG is essential. In the following aspects of the reimbursement system with special relevance to dermatology are reviewed in detail. Additionally, the revised classification system versions OPS-301 SGB V and ICD-10-GM 2004 and the German coding standards version 2004 must be appropriately applied for dermatologic purposes.


Assuntos
Dermatologia/economia , Grupos Diagnósticos Relacionados/economia , Grupos Diagnósticos Relacionados/normas , Programas Nacionais de Saúde/economia , Dermatopatias/classificação , Dermatopatias/economia , Dermatologia/legislação & jurisprudência , Dermatologia/normas , Dermatologia/tendências , Grupos Diagnósticos Relacionados/tendências , Alemanha , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/normas , Programas Nacionais de Saúde/tendências , Padrões de Prática Médica/economia , Dermatopatias/diagnóstico , Dermatopatias/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA